What's happening
This bill requires health plans to allow direct payment to out-of-network emergency providers and limits patient billing for emergency services.
Why it matters
Protects patients from surprise emergency medical bills. by ensuring that out-of-network emergency providers cannot charge more than in-network cost-sharing amounts (like copays, coinsurance, or deductibles).
Empowers patients to direct insurance payments. straight to emergency medical providers (even if out-of-network), eliminating the need for patients to pay up front and seek reimbursement.
Limits balance billing. by prohibiting out-of-network emergency providers from billing patients for any outstanding amount beyond what insurance pays (except for normal cost-sharing), reducing financial stress after emergencies.
Improves claims process transparency and fairness. , requiring providers to refund any mistaken payments from patients if benefits were assigned, and to resubmit unpaid balances to the insurer instead of pursuing the patient.
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Who cares
Headline styles
End Surprise ER Bills
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to rules
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
9077
IN SENATE
June 15, 2018
Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Rules
AN ACT to amend the insurance law, in relation to patient billing for emergency services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (c) of section 3241 of the insurance law, as added by section 6 of part H of chapter 60 of the laws of 2014, is amended to read as follows:
(c) (1) When an insured or enrollee under a contract or policy that provides coverage for emergency services receives the services from a health care provider that does not participate in the provider network of an insurer, a corporation organized pursuant to article forty-three of this chapter, a municipal cooperative health benefit plan certified pursuant to article forty-seven of this chapter, a health maintenance organization certified pursuant to article forty-four of the public health law, or a student health plan established or maintained pursuant to section one thousand one hundred twenty-four of this chapter ("health care plan"), the health care plan shall: (A) ensure that the insured or enrollee shall incur no greater out-of-pocket costs for the emergency services than the insured or enrollee would have incurred with a health care provider that participates in the health care plan's provider network; and (B) provide the insured or enrollee the option of assigning the payment of any benefits due under such contract or policy directly to the health care provider. Whenever, in any health insurance claims form, an insured or enrollee specifically authorizes the payment of benefits directly to a health care provider, the health care provider shall submit claims for benefits to the health care plan and the health care plan shall make payment for any benefits to the health care provider.
(2) Whenever an insured or enrollee specifically authorizes the payment of benefits directly to a health care provider, the health care provider shall not bill the insured or enrollee for payment of any
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD16065-02-8
S. 9077 2
amount other than any applicable copayment, coinsurance and/or deductible unless the health plan fails to honor an assignment of benefits.
(3) The health care provider shall not further bill the insured or enrollee for any remaining balance once the health care plan has made its initial payment for which the insured or enrollee must be held harmless by the health plan, but shall, with notice to the insured or enrollee of the existing balance, resubmit the balance to the health plan. In the event an insured or enrollee mistakenly reimburses a health care provider for emergency services for which the insured or enrollee has assigned payment of benefits pursuant to paragraph one of this subsection, the health care provider shall promptly refund such payment, less any applicable copayment, coinsurance and/or deductible, to the insured or enrollee.
For the purpose of this section, "emergency services" shall have the meaning set forth in subparagraph (D) of paragraph nine of subsection (i) of section three thousand two hundred sixteen of this article, subparagraph (D) of paragraph four of subsection (k) of section three thousand two hundred twenty-one of this article, and subparagraph (D) of paragraph two of subsection (a) of section four thousand three hundred three of this chapter.
§ 2. This act shall take effect on the ninetieth day after it shall have become a law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to patient billing for emergency services
Purpose
To ensure patients do not receive bills for emergency services they are not obligated to pay.
Summary of provisions
Section one amends § 3241(c) of the Insurance Law to provide that when an insured assigns a benefit to a health care provider for emergency services, the health care provider shall submit claims to the plan and the plan shall bill the provider directly. Further, the health care provider is prohibited from billing the insured any amount other than the applicable copayment or deductible. Any payments received by the health care provider that the patient was not obligated to pay, shall be returned to the patient.
Justification
In 2014, New York's monumental Surprise Bill Law expanded hold harmless provisions to ensure consumers incur no greater out-of-pocket costs for emergency services provided out-of-network than they would have incurred if such services were performed by a participating provider. These provisions require the health plan to ensure the consumer is held harm- less, but they did not prohibit a provider from nonetheless billing the consumer. What has resulted is often a scenario where the consumer gets stuck in the middle of a dispute with a provider and the health plan. The provider will bill the consumer, the plan will pay the consumer an approved amount which the consumer has to submit to the provider, and if the provider is not satisfied with the payment, they may bill again causing the cycle to continue. In some instances, patients are not aware they do not have an obligation to pay these bills, and as result they pay the provider out-of-pocket.
This legislation will end this confusing paradigm and further the intent of the 2014 statute by ensuring consumers are actually held harmless for emergency services performed out-of-network.
Legislative history
New bill.
Fiscal implications
None.
Effective date
90 days after enactment.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.